HPV screening and follow-up pathway

Awareness and education

patient reading informationResources for the public

Recommendation 1: Educational materials on HPV primary screening should be made available in a variety of languages, literacy levels and with culturally specific content to reflect participants’ needs.1,2

Key evidence and implementation considerations:

  • Engaging and partnering with communities can help develop materials to meet various needs. Wherever possible, a professionally trained interpreter should be made available to support participants who are from culturally and linguistically diverse backgrounds.
    • Perceptions of cancer and cancer-related issues (e.g., HPV-positive screening) can differ greatly among people from culturally or linguistically diverse backgrounds, and diagnoses can come with additional complexities, especially if English proficiency is poor.3 Communicating vital information and advice can be difficult and stressful for participants.3
  • Cancer programs and agencies should engage with participants from various target populations to determine how best to present educational materials and what information should be included in these materials.

Recommendation 2: Educational materials should include information to combat and reduce stigma associated with HPV to increase acceptability and participation in HPV primary screening.

Key evidence and implementation considerations:

  • Educational materials should explain why HPV primary testing is being used for cervical screening and what an HPV-positive result means.
  • Materials that agencies and programs can develop include but are not limited to FAQs; handouts or cards with links to screening program websites; posters in hospital waiting rooms, clinicians’ offices and community health centres; brochures, pamphlets and question prompt lists; and online resources sent to participants when their appointment is booked.
  • Using technology (e.g., mobile apps, social media) to promote educational materials can help target younger demographics.
  • Stigma or anxiety surrounding an HPV-positive result, and fear of notifying one’s sexual partners, can affect participants’ acceptability and participation in screening.4,5 Jurisdictions should train care providers in supporting patients through complex psychosocial–sexual reactions to an HPV-positive test result, and provide guidance on when to refer to an experienced psychosocial health professional.
  • Providing factual information, explaining the advantages of HPV testing compared to Pap testing, clarifying misconceptions and addressing myths related to cervical screening can tackle stigma and improve screening rates.2
  • A highly effective way to reduce stigma and improve acceptability is to normalize HPV, emphasize the high prevalence of HPV infections (four out of five people have HPV at some point in their lives), and explain that infections can be acquired many years before a positive test.3,4 It is important to remind people that nearly all cervical cancers are caused by infection with high-risk HPV, but now we have the opportunity to test for the cause of abnormal cells usually found with Pap testing — earlier and with a better test.
  • Differentiating HPV from other STIs can help with acceptability and normalization of the transition to HPV primary screening4,6
  • Resources for the public and program implementation can be enhanced with education around HPV and cervical cancer and by normalizing the transmission pathway (which affects all sexes).1

Recommendation 3: Jurisdictions should make educational materials for participants available in a centralized and easily accessible platform (e.g., an organization’s website), including information for relevant contact information such as a centralized program telephone line to refer participants for more information.6

Key evidence and implementation considerations:

  • Jurisdictions should ensure that providers know where educational materials are housed so they can easily refer participants to them.

Resources for providers

Recommendation 4: Jurisdictions should collaborate with healthcare providers to determine key resource needs and ensure providers are equipped to address participant questions and concerns about HPV testing and follow-up for HPV-positive tests.

Key evidence and implementation considerations:

Resource needs may include but are not limited to key messages, continuing medical education modules (with credits), training materials, policies, guidelines, and pathways. Jurisdictions should also consider hosting targeted education sessions, webinars, or conferences for providers during the planning, implementation, and ongoing provision of HPV testing.6

  • In British Columbia, healthcare providers and agencies responsible for cervical cancer screening were the most important sources of information for cervical screening participants.4
  • Develop key messages and train providers to confidently and effectively discuss evidence and the value of HPV primary screening with their patients. For example, providers should be trained to discuss emerging evidence that supports replacing Pap-based screening with HPV primary screening.7
  • Provider materials should support open and clear communication with participants to foster acceptance and participation in HPV screening. Providers should also be aware of how to communicate changes to triage and follow-up protocols so participants who test positive for HPV know what to expect in next steps.
  • Jurisdictions should consult with providers on how they would prefer to exchange and receive information about the changes from cytology tests to HPV tests. Providers may prefer written correspondence instead of in-person or virtual information sessions.
  • All educational activities and materials for providers should be evidence-based and include scientific references6
  • Jurisdictions should consider how provider materials can support open and clear communication with participants to foster acceptance and participation in HPV screening.

Recommendation 5: Support providers who work with First Nations, Inuit and Métis individuals to actively establish trusting relationships with participants and learn about their cultures8

Key evidence and implementation considerations:

  • A positive and understanding relationship with one’s primary care provider is especially impactful for First Nations, Inuit and Métis participants.8 These types of relationships allow participants to voice any concerns, fears or questions they may have with the screening process. They can also help promote acceptability and participation in screening and can improve the overall screening process.8
  • Integrating cultural competence training for providers and ensuring providers understand how Western and Indigenous attitudes and approaches can affect an individual’s beliefs around cervical screening and cancer will:
    • enable healthcare workers to provide culturally competent care to participants
    • ensure participants feel heard and acknowledged by their healthcare provider8
    • promote acceptability and participation in screening8
  • A study with Inuit participants in Quebec found that culturally aware healthcare providers were a major facilitator of positive patient experiences and also of adequate communications between primary care providers and participants.9
    • Inclusive means of communication and positive experiences with healthcare workers helped increase cultural awareness.9
  • Cultural awareness and competency among care providers makes healthcare services more accessible, acceptable and effective.9

Recommendation 6: Jurisdictions should actively support healthcare provider education and training on delivering and practicing trauma-informed care.

Key evidence and implementation considerations:

  • Individuals who have experienced sexual trauma may need additional support to participate in cervical screening and could face difficulty in disclosing histories of sexual abuse or trauma.3 Self-sampling may present an option for these individuals to participate in cervical screening without requiring them to disclose history.
  • If offering self-sampling to participants is not possible and concerns about past trauma arise, providers should engage in safe dialogue with participants to understand their needs, which could include bringing a support person with them to appointments or developing strategies to manage stress and anxiety around re-traumatization during the procedure.3
  • When working with First Nations, Inuit and Métis populations, trauma-informed care may be particularly important, recognizing that many beliefs or concerns around HPV testing and screening is an accumulated impact of colonization.10
  1. Clark M, Horton J. Self-sampling devices for HPV testing. Canadian Journal of Health Technologies. 2021; 1(12). https://doi.org/10.51731/cjht.2021.229. 
  2. Access Alliance. Critical discussion report: Reducing inequities in cervical cancer screening among newcomer women via HPV self-sampling. 2022.
  3. Government of Australia. Optimal care pathway for women with cervical cancer.https://www.cancer.org.au/assets/pdf/cervical-cancer-optimal-cancer-care-pathway 
  4. Smith LW, Racey CS, Gondara L, et al. Women’s acceptability of and experience with primary human papillomavirus testing for cervix screening: HPV FOCAL trial cross- sectional online survey results. BMJ Open. 2021; 11:e052084. doi:10.1136/ bmjopen-2021-052084
  5. Pantano N, Fregnani J, Resende, J, et al. Evaluation of human papillomavirus self-collection offered by community health workers at home visits among under-screened women in Brazil. Journal of Medical Screening. 2020; 28(2):163-168. doi:10.1177/0969141320941056
  6. Canadian Partnership Against Cancer. National guidance document on HPV testing for primary screening of cervical cancer. 2016.
  7. Hahn EE, Munoz-Plaza C, Altman DE, et al. De-implementation and substitution of clinical care processes: Stakeholder perspectives on the transition to primary human papillomavirus (HPV) testing for cervical cancer screening. Implement Sci Commun. 2021; 2(1):108. doi:10.1186/s43058-021-00211-z
  8. O’Brien B, Mill J, Wilson T, et al. Cervical screening in Canadian First Nation Cree women. Journal of Transcultural Nursing. 2008; 20(1):83-92. https://doi.org/10.1177/1043659608322418 
  9. Tratt E, Sarmiento I, Gamelin R, et al. Fuzzy cognitive mapping with Inuit women: What needs to change to improve cervical cancer screening in Nunavik, northern Quebec? BMC Health Services Research. 2020; 20(1):529. 
  10. Henderson RI, Shea-Budgell M, Healy C, et al. First Nations People’s perspectives on barriers and supports for enhancing HPV vaccination: Foundations for sustainable, community-driven strategies. Gynecologic Oncology. 2018; 149(1):93-100.